On 6 February 2005, the Co-op pharmacy on Scott Street in Keighley, West Yorkshire, received a prescription for atenolol from Dr Gill in the adjacent Ling House Medical Centre. 25mg, once daily.
The prescription itself was routine; it’s prescribed to thousands of patients across England each day. What set this one apart was the way it was sent.
Instead of coming into the pharmacy through the front door in the form of a little green paper slip in the hands of a patient, it had been sent directly from the IT system in the surgery to the computer in the pharmacy. The Electronic Prescription Service (EPS) was born, and a digital revolution in prescribing in the NHS had begun.
Dr Ian Lowry, Director at NHS Digital (now NHS England), recalls that day in February. “They opened the practice and pharmacy on a Sunday just for us so there would be no impact on patients. I remember it was raining,” he says.
We started dancing around the aisles of the pharmacy.
“We fired off some test prescriptions, the pharmacy downloaded them and there it was: it worked. We started dancing around the aisles of the pharmacy.”
Lowry and his team had reason to celebrate. That first electronic prescription was the culmination of 2 years’ work for his team.
“Our task was basically to turn the government aspiration of a national prescription service into a reality,” he says. “It was an enormous feat – we needed to connect about 9,000 GP practices with 11,500 community pharmacies. At the time, there were about 1.8 million green FP10 paper prescriptions generated each day.”
The team spent much of those 2 years carefully planning the architecture behind the service. “The underlying technology hasn’t changed in 20 years,” Lowry explains. “We built it for simplicity and it has stood the test of time.”
The service has been on a continuous improvement journey since then.
It took more than a decade for the tide to turn from paper to digital prescriptions in primary care.
“Don’t underestimate the amount of business change that was needed for this,” Lowry says. “For 60 years, people were used to those green paper prescriptions. It took time for things to change.”
Now, nearly all GP practices across England are live with EPS and 95% of prescriptions are sent electronically to community pharmacies.
Dr Adeem Rubani is a GP partner at Ling House Medical Centre. He says EPS has been a “game-changer” for those working in primary care.
Gillian Edwards was the Practice Manager at Ling House Medical Centre and unlocked the door on that Sunday in 2005. “I remember it was really exciting,” she says. “Since then, EPS has really helped our practice over the years. We used to have stacks of green prescription forms that GPs had to go through and sign by hand. We then filed them in drawers and had a steady stream of patients and pharmacy staff through our doors to collect them. Now that almost everything is electronic, our reception team and prescription clerk have a lot more time to do their jobs.”
"Our reception team and prescription clerk have a lot more time to do their jobs."
Gillian Edwards, Practice Manager, Ling House Medical Centre
For prescribers, it’s easier to sign repeat prescriptions, and cancel or amend prescription items. Prescriptions do not get lost between the clinician and the dispenser.
Patients can select or ‘nominate’ a pharmacy of their choice and have their prescription sent straight there, minimising the time they need to wait to collect it.
And dispensers at community pharmacies no longer need to transcribe paper prescription information. Standardised information reduces queries and the likelihood of the wrong medication being dispensed. The end of month claim process is also far more efficient.
We had a team of 850 people working full-time to scan and process them for payment.
NHS Business Services Authority (NHSBSA) is responsible for reimbursing community pharmacies for the cost of NHS prescriptions. To do this, every month it collects and processes prescription records from each of the 11,500 community pharmacies across England.
“Before EPS, pharmacies used to spend hours – sometimes days – at the end of the month sorting green FP10 forms into boxes for secure transport to us,” recalls Martin Hagan, Senior Service Improvement Manager at NHSBSA. “We had a team of 850 people working full-time to scan and process them for payment. By the time they were finished, the next batch of 11,500 boxes arrived. We had warehouses full of them.”
Now, when a prescription is dispensed using EPS, a digital record is sent to NHSBSA instead of the green FP10 form. Some of the warehouses have closed and the team has shrunk to 280 people. No redundancies were made. Instead, staff were upskilled and redeployed to work on other activities within the organisation.
So what’s next for the EPS programme?
“Over the past few years EPS has held its position and done what it’s needed to do in primary care,” says Rahul Singal, Chief Pharmacy and Medicines Information Officer at NHS England. “Now, especially after the COVID-19 pandemic and the rise in remote consultations and virtual wards, we’re seeing the need to expand it into more care settings.”
It is not too dramatic to state that EPS has revolutionised my practice.
Outpatient clinics, for example, provide treatment to people who are seen by a hospital clinician. When they issue a prescription, it’s usually a paper one that needs to be dispensed at the hospital outpatient pharmacy before the patient returns home. But what happens if they have their appointment over the phone or online, not in person?
“There have been a mix of workarounds in hospitals since the pandemic,” explains Singal. “Some ask patients to come in and collect prescriptions; others have devised an infrastructure to effectively deliver paper prescriptions to community pharmacies, or deliver medications direct to patients. In all these cases, it introduces an increased delay between a decision to initiate treatment and the medication being available for the patient.”
Before secondary care providers can implement EPS, however, IT system suppliers need to complete technical development work. “Our next challenge is to encourage more suppliers to build EPS into their systems," says Singal. "This is a big task because there are multiple suppliers in secondary care who each have their own development priorities.
“Alongside this, we’re also improving and innovating the existing service – for example, we’re working on functionality that would allow patients to track their prescription on their mobile phone. Essentially, we want EPS to do more things in more places.”
The Scott Street pharmacy is now part of the Well pharmacy group. Pharmacist Aneta Paluch is branch manager there. She began practicing in England 8 years ago when the adoption of EPS across primary care was gaining momentum.
“Things have improved a lot over the years,” Paluch reflects. “EPS makes it easier for everyone.” She would love to see the service introduced in secondary care.
Midlands Partnership Foundation Trust is the first secondary care provider in England to implement EPS, and the feedback from staff has been overwhelmingly positive.
"It is not too dramatic to state that EPS has revolutionised my practice,” says Dr James Briscoe, Consultant Psychiatrist in the Early Intervention team. “I can now write and deliver prescriptions in 5 minutes compared to the time and effort it took to handwrite a prescription from scratch, arrange for it to be collected by the service user or a member of the team or hand deliver it to a pharmacy. A huge time saving with inbuilt safeguards to enable safe prescribing.”
Reflecting on what EPS has achieved, Lowry says, “It is one of the most successful and impactful programmes NHS Digital has done, and the best thing I’ve ever worked on.”
Singal agrees: “I think we’d be pushed to think of another national system that’s had more success and transformational impact in the NHS. When you look at the number of transactions and how much it’s revolutionised practice, I don’t think any clinician would want this taken away from them.”
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Last edited: 6 October 2023 2:12 pm